Lipedematous Alopecia: Could it Sometimes be an Unusual Sequela of Discoid Lupus Erythematosus?

Lipedematous alopecia is a rare entity of uncertain etiology characterized by a diffusely thickened and boggy scalp, with varying degrees of alopecia. Six of eight cases in the literature have occurred in African American women. Classic histopathologic findings include increased subcutaneous tissue, varying degrees of inflammation and fibrosis, and an absence of significant mucin deposition. Herein, we report an additional case of lipedematous alopecia occurring in an African American woman who also demonstrated clinical, historical, and histopathologic findings reminiscent of discoid lupus erythematosus. Explicit observation of such an occurrence has not been made previously, although hyperkeratosis, follicular plugging, mild perivascular or periadnexal infiltrates, and fibrosing alopecia have been reported in lipedematous scalp, possibly the residua of other cases with associated discoid lupus‐like features. For further comparison, we contrast our case with a second patient with lipedematous scalp, which maintained histological similarities to lipedematous alopecia, but was lacked any significant hair loss. It is possible that some cases lipedematous alopecia may represent an unusual sequela of discoid lupus erythematosus. Nevertheless, we cannot exclude the possibility of two diseases occurring independently, nor that early changes of lipedematous alopecia might share histopathological and/or clinical findings with discoid lupus erythematosus.